Journal Article

Sex-based differences in inflammatory predictors of outcomes in patients undergoing mechanical thrombectomy: an inverse probability weighting analysis

Al-Karadsheh, Hakam, Zahid, Hamza, Foschi, Matteo, Abdalkader, Mohamad, Sacco, Simona, Nguyen, Thanh N., D’Anna, Lucio, Klein, Piers, Komauli, Filippo, Banerjee, Soma, Gartner Jarmillo, Adelaida, Del Regno, Caterina, Lobotesis, Kyriakos, Gigli, Gian Luigi, Merlino, Giovanni, Zhang, Liqun, Malhotra, Paresh, Toraldo, Francesco, Manganotti, Paolo, Valente, Mariarosaria, Prandin, Gabriele, Maisano, Domenico, Ornello, Raffaele

2025

Overview

Background: Inflammatory biomarkers, key predictors of ischemic stroke prognosis, may exhibit sex-specific predictive patterns. Objectives: This study investigates sex-based differences in inflammatory biomarkers as predictors of 90-day clinical outcomes in acute ischemic stroke patients undergoing mechanical thrombectomy (MT). Design: Multicenter retrospective study. Methods: This study included 970 patients consecutively treated with MT for anterior circulation large vessel occlusion between 2016 and 2023. Inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio (MLR), C-reactive protein (CRP), systemic inflammation response index, and systemic immune-inflammation index, were measured on admission and 24-h post-MT. Inverse probability weighting was used to balance baseline characteristics between male and female patients. Least absolute shrinkage and selection operator regression and logistic regression were used to identify independent predictors of 90-day good functional outcomes (modified Rankin scale (mRS) score 0–2) and death, stratified by sex and age groups (<55 and ⩾55 years). Results: In the male weighted population (516 patients), multivariable analysis showed that MLR (odds ratio (OR): 0.37, 95% confidence interval (CI): 0.13–0.95, p = 0.041), 24-h NLR (OR: 0.88, 95% CI: 0.83–0.94, p < 0.001), and 24-h MLR (OR: 0.33, 95% CI: 0.12–0.94, p < 0.001) were independent predictors of 90-day good functional outcome with age-specific differences noted. Twenty-four-hour MLR (OR: 5.05, 95% CI: 1.36–4.28, p = 0.047) and erythrocyte sedimentation rate (OR: 1.02, 95% CI: 1.01–1.04, p = 0.025) were independent predictors of death, respectively, for men <55 and men ⩾55 years. In the weighted female population (454 patients), 24-h NLR (OR: 0.89, 95% CI: 0.81–0.96, p = 0.007) and 24-h CRP (OR: 0.98, 95% CI: 0.97–0.99, p = 0.029) were independent predictors of good functional outcomes. Twenty-four-hour CRP was also an independent predictor of 90-day death (OR: 1.01, 95% CI: 1.00–1.02, p = 0.017) in women with no age-specific differences noted. Interaction analysis revealed significant sex-specific relationships for MLR and CRP but not for NLR. Conclusion: This study highlights sex-based differences in the predictive value of widely available inflammatory biomarkers for stroke outcomes. MLR was a distinct predictor in men, while CRP was uniquely associated with outcomes in women. These findings underscore the need for sex-stratified approaches in stroke management and research. Plain language summary Understanding how sex influences the inflammation response after large strokes, using a method called inverse probability weighting analysis Why was the study done? Inflammatory markers are important for predicting how well a person will recover from an ischemic stroke. These markers may affect men and women differently. This study looks at how these markers predict recovery in men and women after undergoing mechanical thrombectomy (MT) for an acute ischemic stroke. What did the researchers do? This study included 970 patients treated with MT for large vessel occlusion. Several inflammatory markers were measured when the patients arrived at the hospital and 24 hours after the thrombectomy. The study used a statistical method called inverse probability weighting to adjust for differences between male and female patients. Different statistical models were used to find predictors of good recovery and death, based on gender and age groups (<55 years and over 55 years). What did the researchers find? For men (516 patients), the analysis showed that higher admission MLR (an inflammatory marker based on blood cells) and NLR (another blood-cell-derived marker) 24 hours after the procedure were linked to better recovery. Additionally, higher MLR 24 hours after MT and ESR (a different marker) were linked to a higher risk of death in younger and older men, respectively. For women (454 patients), NLR and CRP (inflammation-related blood protein) 24 hours after MT were linked to better recovery. CRP was also associated with a higher risk of death, but there were no differences based on age in women. What do the findings mean? The study shows that men and women may have different inflammatory markers that can predict stroke recovery. For men, MLR was a key marker, while for women, CRP was more important. These findings suggest that stroke treatment and research should consider sex-based differences to improve patient outcomes.

• Publisher: SAGE Publications,SAGE PUBLICATIONS, INC,SAGE Publishing
• Subject: Age / Age groups / Biomarkers / Blood cells / C-reactive protein / Death / Erythrocyte sedimentation rate / Females / Inflammation / Ischemia / Leukocytes (neutrophilic) / Lymphocytes / Monocytes / Occlusion / Original Research / Patients / Sex / Statistical models / Stroke / Women